Treatment Of Portal Vein Cancer

The rapid and aggressive spread of pancreas cancer into surrounding tissue, its resistance to standard chemotherapy and its tendency to recur make it one of the most challenging cancers to treat. At Mayo Clinic, physicians dedicated solely to pancreas care combine their expertise to develop comprehensive treatment programs for people with all stages of pancreatic cancer. Surgery, radiation, and palliative care may each be needed. For many people, managing symptomsis also a critical part of care. The most appropriate options for you depend on the location and extent of the cancer, your age, overall health and personal wishes.

Surgery

Surgery is the best option for people whose cancer can be safely and effectively removed. This usually means that the tumor hasn't grown into any of the major blood vessels located near the pancreas or spread to the liver, abdominal cavity or lungs.

Unfortunately, only about 20 percent of pancreatic cancer patients have tumors that can be surgically removed (resected). And although improvements in diagnosis, staging, surgical techniques and postoperative care have led to much better outcomes after surgery, pancreatic resection is still one of the most difficult and demanding operations for both surgeons and patients.

Many studies have shown that patients do far better at centers such as Mayo Clinic, where highly skilled surgeons have particular training and expertise in pancreatic surgery and perform a large number of these procedures every year.

Pancreatic surgeries offered at Mayo Clinic include:

                  

• Whipple procedure. Also known as pancreatoduodenectomy, the Whipple procedure is the most common surgery for pancreatic cancer. To ensure the best outcome, the American Cancer Society recommends that you undergo this surgery in a center that treats a large number of pancreatic cancer patients. Mayo Clinic physicians have extensive experience with the Whipple procedure, performing more than 100 of these complex operations every year.
  
  The surgery involves removing the "head" of the pancreas — the wide part of the pancreas next to the duodenum, the first part of the small intestine. To do that, surgeons must remove the duodenum, the gallbladder, the end of the common bile duct and sometimes part of the stomach. The intestine, bile duct and remaining part of the pancreas are then reconnected. One not uncommon complication of this surgery is leaking of pancreatic juices from the suture line. The leaking usually stops over time with no additional treatment.
  
  Weight loss is another frequent complication of the Whipple procedure. On average, patients lose about 7 percent of their pre-operative bodyweight after surgery. Because the pancreas contains insulin-producing cells, diabetes is also a potential complication. Yet most people who have normal blood sugar before surgery don't develop diabetes and those with recently developed diabetes actually improve after surgery. In general, although many people do very well after the Whipple procedure, up to a third may develop immediate complications that affect their quality of life.
  
  After pancreatic surgery, it will take some time before you can eat normally, and you may need long-term treatment with pancreatic enzymes to help you digest food properly. Pancreatic enzymes, nutrition counseling and supportive care are an integral part of Mayo's comprehensive pancreatic cancer treatment.

• Minimally invasive surgery. In select cases, the Whipple procedure can be performed using a minimally invasive (laparoscopic) procedure. Although very successful in the right hands, this technique requires great skill because the surgery is performed through a few small incisions rather than a single large incision. Mayo Clinic surgeons have extensive experience in laparoscopic Whipple procedures, which can provide important benefits to patients, including less blood loss, a shorter hospital stay, a faster return to normal activities and a reduced risk of complications.
• Central pancreatectomy. In certain cases, some Mayo Clinic surgeons perform a highly specialized surgery called central pancreatectomy, which removes the center portion or body of the pancreas, while retaining both ends (the head and tail). This procedure is performed in very few medical centers in the United States and is generally used for early-stage benign tumors in the neck of the pancreas — a difficult area to treat without removing a large portion of the gland. By preserving more of the pancreas — and thus more of the cells that produce insulin and digestive enzymes — central pancreatectomy reduces the risk of diabetes and severe digestive problems.
• Other surgical procedures. Mayo Clinic surgeons offer other options for pancreatic cancer, including total pancreatectomy, which removes the entire pancreas, along with the gallbladder, part of the stomach and small intestine, the bile duct, spleen, and nearby lymph nodes; and distal pancreatectomy, in which the body and tail of the pancreas are removed.

Radiation therapy and multi-modality therapies

Mayo Clinic radiation oncologists have particular expertise in the most advanced therapies, including intensity modulated radiation therapy, which uses hundreds of small radiation beams of varying intensities to precisely target cancer cells, while sparing healthy tissue.

At Mayo Clinic, radiation is almost always given in conjunction with chemotherapy (chemoradiation) for tumors that can't be removed. It's also used before or after surgery to reduce the size of tumors and destroy cancer cells that may have spread beyond the pancreas.

Radiation can be even be delivered during surgery usingintraoperative radiation electron therapy, a procedure pioneered by Mayo Clinic physicians. Intraoperative radiation electron therapy allows doctors to treat tumors with high doses of radiation — the equivalent, in some cases, of 10 to 20 daily radiation treatments — without harming nearby organs.

Mayo Clinic's intraoperative radiation therapy program is one of the world's largest, and Mayo physicians are highly experienced in this procedure. Studies at Mayo Clinic suggest that patients live longer when treated with an aggressive course of chemoradiation before surgery along with intraoperative electron radiation during surgery.

Palliative care

When cancer is so advanced that treatment options are limited, an experienced, integrated team of palliative care providers serves the social, psychological and spiritual needs of patients and their families. Your care team may include physicians from a number of fields as well as dietitians, medical social workers, chaplains, psychologists, pharmacists and pain management specialists.

If you are facing a serious prognosis, your primary treatment team will consult with a Mayo Clinic palliative care expert who then works with your primary Mayo physicians. Mayo Clinic is committed to providing every patient with compassionate end-of-life care.